Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 122300000X | Dentist | 3543 | AR |
Y | 1223P0700X | Prosthodontist | 16 | AR |
NPI | 1245441526 |
---|---|
Provider Name | Dr. Jonathan Michael Hart |
First Address | Little Rock, AR 72227-2419 |
Second Address | Little Rock, AR 72227-2419 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2007 |
Last Update Date | 20/04/2020 |